Oxybutynin and Cognitive Impairment – Case Scenario

A 75-year-old female has a history of mild cognitive impairment, GERD, hypertension, osteoarthritis, and overactive bladder. Recognizing the relationship of oxybutynin and cognitive impairment is incredibly important in geriatrics and in the case scenario, we outline some ways to resolve this issue. Her current medications include:

Omeprazole 20 mg daily
Ibuprofen 400 mg BID PRN
Diclofenac gel PRN
Amlodipine 10 mg daily
Lisinopril 5 mg daily
Oxybutynin (podcast episode) 5 mg BID

The patient’s daughter presents with this patient today and is reporting that her mother’s cognition is getting worse. She can’t seem to remember names, forgets where she puts things, and is disoriented to place and time as well. She will also try to cook things and forgets to shut off the stove. She has been reading on the internet about oxybutynin and cognitive decline and wondering if this medication should be discontinued.

In this case scenario, oxybutynin is not the best choice for the treatment of overactive bladder. It is one of the older urinary anticholinergic medications as far as central nervous system penetration and adverse effects. This medication is likely to worsen cognitive impairment and should be changed. I find that it often gets prescribed because it is inexpensive and many clinicians have experience in using it for overactive bladder.

There are a couple of options that may be considered in this situation. If we wanted to continue using a medication in the same class as oxybutynin, trospium would be the best option. It has reduced CNS penetration and would be less likely to worsen cognitive impairment. This is a great nugget to remember for your pharmacist board certification exam 🙂

Our other option to consider is a urinary beta-agonist. Mirabegron and vibegron are two such options. In practice, I see mirabegron used a little more frequently than vibegron. I’ve done a comparison of these agents in the past that would definitely be worthwhile to review if you are unfamiliar with either of these agents.

How often do you see case scenarios of oxybutynin and cognitive impairment?

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